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Abstract
Objective To investigate whether immune cell composition and content of neutrophil extracellular traps (NETs) in relation to clinical outcome are different between acute ischemic stroke (AIS) and acute myocardial infarction (AMI), we performed histologic analysis and correlated results with clinical and procedural parameters.
Methods We retrieved thrombi from patients with AIS (n = 71) and AMI (n = 72) during endovascular arterial recanalization and analyzed their immune cell composition and NET content by immunohistology. We then associated thrombus composition with procedural parameters and outcome in AIS and with cardiac function in patients with AMI. Furthermore, we compared AIS thrombi with AMI thrombi and differentiated Trial of Org 10172 in Acute Stroke Treatment classifications to address potential differences in thrombus pathogenesis.
Results Amounts of leukocytes (p = 0.133) and neutrophils (p = 0.56) were similar between AIS and AMI thrombi. Monocytes (p = 0.0052), eosinophils (p < 0.0001), B cells (p < 0.0001), and T cells (p < 0.0001) were more abundant in stroke compared with AMI thrombi. NETs were present in 100% of patients with AIS and 20.8% of patients with AMI. Their abundance in thrombi was associated with poor outcome scores in patients with AIS and with reduced ejection fraction in patients with AMI.
Conclusion In our detailed histologic analysis of arterial thrombi, thrombus composition and especially abundance of leukocyte subsets differed between patients with AIS and AMI. The presence and amount of NETs were associated with patients' outcome after AIS and AMI, supporting a critical impact of NETs on thrombus stability in both conditions.
Glossary
- AIS=
- acute ischemic stroke;
- AMI=
- acute myocardial infarction;
- CE=
- cardioembolism;
- EF=
- ejection fraction;
- H&E=
- hematoxylin and eosin;
- LAA=
- large artery atherosclerosis;
- MLKL=
- mixed lineage kinase-like;
- mRS=
- Modified Rankin Scale;
- NET=
- neutrophil extracellular trap;
- NIHSS=
- National Institutes of Health Stroke Scale;
- PAD4=
- peptidylarginine deiminase 4;
- PBS=
- phosphate-buffered saline;
- ROC=
- receiver operating characteristic;
- TF=
- tissue factor;
- TICI=
- thrombolysis in cerebral infarction;
- TOAST=
- Trial of Org 10172 in Acute Stroke Treatment
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to the manuscript.
Editorial, page 955
- Received May 8, 2019.
- Accepted in final form January 7, 2020.
- © 2020 American Academy of Neurology
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